Mortality After Osteoporotic Vertebral Body Fractures: Cement Augmentation Versus Conservative Treatment—A Systematic...

Osteoporotic vertebral body fractures are associated with a 1-year mortality of 28%, a figure similar to that for hip fractures. Retrospective registry studies from multiple countries have shown a survival advantage in patients treated with an augmentation procedure.

We carried out a systematic review of publications retrieved from the PubMed, Livivo, Cochrane Central, and Web of Science databases, and from the internet at large via Google Scholar. Studies were selected for analysis if they included a comparison of mortality in patients with osteoporotic vertebral body fractures who were treated conservatively versus those who were treated with cement augmentation. We also carried out a pooled quantitative analysis based on the findings of all studies in which a hazard ratio (HR) comparing the two modes of treatment was reported.

22 publications met the inclusion criteria, including two randomized, controlled trials (RCTs). The two RCTs and 8 of the remaining studies showed no significant difference in mortality between the two groups; a significant positive effect of augmentation was reported in a further 11 studies, and a significant negative effect in 1. 11 studies were suitable for inclusion in the quantitative analysis. The pooled HR for death was 0.91 (95% confidence interval [0.73; 1.15]; p = 0.39), i.e., mildly in favor of augmentation, but statistically insignificant.

A wide variety of confounders may have led to an overestimation, in retrospective studies, of the survival advantage putatively conferred by cement augmentation of vertebral body fractures compared to conservative treatment. Our systematic review and meta-analysis revealed no significant association of either form of treatment with a higher survival rate.